Each year, more than 1.5 million people in the country require an organ transplant: 10,000 receive one. Hoping to find a solution to the extreme shortage, the Red Cross rolled out a pilot education and enrollment program in 11 provinces and municipalities last year hoping to teach people how they could save lives after their own death.

It failed. In Nanjing, the capital of Jiangsu Province, not one person has elected to be a donor.

Experts warn that the need for organs is increasing while the supply has remained static. With the country set to fall short by 1.49 million organs again this year, many are asking why people are so unwilling to give.

Miserable Results

“We received several calls from people curious about the program, but not one agreed to become a donor,” said Liu Wenhua, a member of the Red Cross of Nanjing.

The capital city of Nanjing was one of 11 regions selected for the 2010 pilot program that began last March. The program, under the supervision of The Red Cross Society of China, was intended to create a network that would oversee donations, stamp out illegal organ trade and ensure that organs reached those patients most in need.

The Red Cross had hoped to collect data on which to base a future nationwide program with the aid of the central government.

During this trial period, the Red Cross encouraged people to become voluntary posthumous organ donors. This list would be used to connect patients with people who could provide livers, kidneys, hearts, skin and corneas.

Liu said he was one of 12 “donation counselors” sent by the city government to five hospitals. Their job was to educate people about the benefits of organ donation and to put donors in contact with patients’ families.

“But I never managed to persuade even one person,” Liu said, noting that only three people in Nanjing have donated organs in the past 20 years.

Success was equally absent in other regions. As of last Thursday, only 37 people nationwide had registered to donate their organs.

China performs the second most organ transplants in the world, trailing only the US – but demand far exceeds supply.

According to data from the Ministry of Health, one in every 150 patients in need receives a lifesaving organ transplant: in the US, that ratio is one in every five.

The huge shortage of donor organs has created a significant black market despite a national ban on organ trafficking.

Obstacles

Like so many other problems, the nation’s shortage of donors is based on “traditional thinking.” Few are willing to embrace what seems to be a new concept, Liu said.

“Many Chinese people believe that the body must be complete when it is cremated.” Liu said.

Weak legislation makes the issue even thornier. Under the current regulations, family members of the deceased can override their commitment to organ donation, he said.

Liu said one woman who had agreed to donate her organs after death had her body reclaimed by her parents and taken back to their hometown for cremation.

Furthermore, hospitals are given no right to use a dead person’s organs even if he or she has no family. Liu said one migrant worker who died of a sudden cerebral hemorrhage in a local hospital had organs that could have been immediately transplanted, but because his family could not be located they had to give up the procedure.

Even when consent is given it is possible for the procedure to go awry. Donors who turn out to have a health condition such as hepatitis B become unqualified, Liu said.

And even when everything else works out, few hospitals are equipped to retrieve, store and transplant organs as key ones like the liver must be taken within 5 minutes of the heart stopping or they become useless.

“When a donor dies, a special medical team must work quickly to remove and preserve his organs before they are lost. Only five hospitals in Nanjing have this capability,” Liu said.

He said organs like the heart, liver and kidneys should be collected after brain death, but lawmakers and the courts have yet to shape a legal definition of the concept. Doctors who harvest organs from dead patients who are being kept alive through artificial respiration could open themselves to civil or criminal legal action.

Paid Organ Donors

New laws under consideration could allow organ donors to receive financial aid for their medical bills and children’s schooling, as well as preferential policies for health insurance and taxation, said Huang Jiefu, the vice-minister of health, at last week’s political assembly.

It was the first time the government announced plans to compensate donors.

“It seems that many other countries support this kind of approach,” Huang said. “The donation is voluntary, free and public.”

Huang said the subsidies would be provided by a government-recognized third party, and that relevant facilities are being constructed.

The ministry is planning to extend the one-year national pilot for another six months. It could go nationwide in two years.

“When the system goes nationwide – given the rising spirit of volunteerism – more people will donate organs to help save those who would die without transplants,” Huang said.

He said willing organ donors who die due to traffic accidents or strokes will be the best candidates.

Good Examples

While no country in the world has enough donors, many have had great success in narrowing the gap between supply and demand.

Spain has the most organ donations each year with 34.4 donors per million citizens, thanks to donations from family members of elderly people who have died, according to the 2010 edition of the EU’s newsletter Transplant published late September.

The Spanish government began developing its national network of transplant coordinators in 1989. All work in hospitals and monitor emergency wards for potential donors. When they learn of a death, they try to persuade relatives to allow the person’s organs to be harvested. Only 15 percent of families refuse.

The country is also the best example of an “opt-out” organ donation system, known as “presumed consent.”

Under such policies, citizens are considered organ donors upon their death unless they have explicitly stated otherwise. The purpose of the system is to expand the pool of organ donors, and to help change social norms about the appropriateness of organ donation.

The US has a donor rate of 26.3 donors per million citizens. The rate is 14.7 per million in the UK and 12.1 per million in Australia.

In the US, people are usually asked to donate when they apply for a driver’s license – the assumption being that their organs may be donated if they are killed in a car accident. The system allows a doctor to remove the dead donor’s organ without family consent.

In China, this question would be considered offensive.

Many countries are experimenting with other measures to increase willingness to donate organs. Israel became the first country in the world last year to give organ donors priority treatment if they require a transplant themselves. Officials hope the incentive will increase the supply of available organs.

Some countries have proposed legalizing the sale of some organs for money, as is the case in Iran. But such policies are controversial and not allowed in China for fear of “crowding out” altruistic motives.

“With such an immense population base, China should be capable of having a great source for transplants,” said Gu Dening, a Jiangsu media commentator.

“Far more needs to be done to foster education, understanding and social acceptance of the practice,” Gu said, calling for an end to “traditional concepts.”

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